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Vision-threatening lesions developing with longer-term follow-up after treatment of neovascular age-related macular degeneration.

Abstract：

PURPOSE:To assess the development of vision-threatening lesions at least 3.5 years after initiating anti-vascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) in eyes with age-related macular degeneration (AMD). DESIGN:Retrospective cohort study. PARTICIPANTS:A total of 75 patients (81 eyes) with CNV secondary to AMD who received intravitreous anti-VEGF treatment and were followed for at least 3.5 years after initiating treatment. METHODS:Retrospective record review of patients initiating anti-VEGF treatment between November 2005 and June 2008 at a university-based institution for whom at least 3.5 years of follow-up was available at the same institution. MAIN OUTCOME MEASURES:Predominantly hemorrhagic lesions or geographic atrophy (GA). RESULTS:Among 75 patients (81 eyes; 59% were women; median age, 78 years), mean follow-up was 4.9 years and at least 6 years for 40%. Median visual acuity (VA) was 20/80 (interquartile range [IQR], 20/50-20/100) initially, 20/63 (IQR, 20/40-20/160) at 2 years, 20/80 (IQR, 20/40-20/200) at 3.5 years, and 20/63 (IQR 20/32-20/200) at 6 years. Six eyes (7%) had predominantly hemorrhagic lesions initially, whereas this developed in an additional 3 eyes (4%, 95% confidence interval [CI], 1% to 10%) in 3.5 years and in 1 additional eye (1%, 95% CI, 0.03% to 7%) at more than 3.5 years of follow-up. Initially, GA within or overlapping the boundary of the entire CNV was present in 4 eyes (5%) and outside this boundary in 8 eyes (10%). Geographic atrophy enlarged in each eye over time. The only eyes that developed GA outside the CNV boundary were those that had GA outside the lesion at baseline. Additional atrophy within the boundary of CNV defined at baseline, termed "atrophic disciform scars," developed in 5 eyes (6%), all within 4 years of treatment initiation. CONCLUSIONS:Longer-term follow-up of neovascular AMD managed with anti-VEGF therapy suggests that predominantly hemorrhagic lesions may develop within 3.5 years of initiating therapy and more than 3.5 years after initiating therapy. In contrast, new areas of GA beyond the boundaries of the CNV lesion as defined at initiation of anti-VEGF therapy seem unlikely to develop if there is no GA outside of the CNV lesion initially.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Tanaka E,Chaikitmongkol V,Bressler SB,Bressler NM

doi

10.1016/j.ophtha.2014.07.046

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

153-61

issue

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(14)00690-3

journal_volume

122

pub_type

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Vision-threatening lesions developing with longer-term follow-up after treatment of neovascular age-related macular degeneration.